At Methodist Central it’s filled with patients who have catastrophic conditions such as quadriplegia and advanced stages of muscular dystrophy and can’t breathe themselves. Instead, machines breathe for them.

Medical assistants, nurses and other staff, concentrated in greater numbers here, are in constant motion, doing everything from simple cleaning to monitoring the high-tech gadgetry that fills each room.

It’s a world into which Dr. Jeffery Warren fits easily.

Rarely still, but always at ease, he attacks each task with equal parts focus, efficiency, and hyperkinetics. Dubbed the “Little Whirlwind” by personnel at his Chickasaw Gardens-area practice, Warren, about 5 feet 8 and heavyset, zips from floor to floor on his morning rounds.

It’s not even 7 a.m. when he passes through the automatic doors of the ventilation ward, and he’s already seen four patients, waking most of them by abruptly turning on the light above their beds while speaking in soothing tones and calling them “sweetie,” “honey” or “my friend.” Yet his fifth patient of the morning is already awake, and greets him with a near smile and a single blink of his eyes.

The patient has ALS, or Lou Gehrig’s disease, and has lost the use of most of his body, including the ability to speak. “His brain is there, but he can’t move,” says Warren.

Gently holding his arm, Warren looks him over. He’s working on moving him to a new room, “down closer to the girls,” he says. Again, there’s what looks like a smile.

Warren moves out into the hall, where he, his student doctor from the University of Tennessee medical school, and a nurse talk about getting this patient a new room. The “girls” are hospital staff who work at the ward’s desk.

“If all you can do is lie there, watch TV and look at what’s going on, that makes a big difference,” says Warren.

Warren reviews the patient’s chart, greets the staff and reviews the case with his med student and a reporter — all without missing a beat. It’s an energy level he maintains for the rest of the day, as well as the next, each of which begins about 5 a.m. and ends as late as midnight, when he receives and returns his last page.

Many hats

All the while, he wears many hats — doctor, businessman and physician activist. And rarely misses an opportunity to do the small things that make a big difference.

In any day, Warren, a family practitioner who’s twice been voted by fellow physicians to Woodward/White’s list of Best Doctors in America and who was the first family doctor to receive UT’s clinical instructor of the year award, talks to patients, consults with doctors, reviews charts and billing at the hospital, and examines more than 25 patients a day at his office, Primary Care Specialists in Chickasaw, suffering from such maladies as hypertension, depression, allergies, cuts, bruises, even post traumatic stress disorder.

His days don’t look like “ER” on television. No gurneys, no mangled patients crash through doors. No doctors shout orders. His is a general practice, everyday problems of everyday people diagnosed and hopefully cured.

It is also a business — one like any other that makes payroll and rent — but it’s also a business under siege, as the industry struggles with delivering service amidst tumultuous change.

“We went six weeks without paying ourselves,” says Warren.

Warren, a 43-year-old Yale and Duke med school graduate who moved here in 1988, offers a study in microcosm of the issues facing the industry.

He’s a partner in a medium-size practice that has undergone its own upheaval. Two doctors, Eduardo Cabigao and Fidel Maka-pugay, left him and one other partner to go on their own in April mainly because of problems with Medicare patients, about 50 percent of the practice’s business.

Apparently, the federal health-care agency dramatically slowed payments to area practices, including Primary Care Specialists, for the first two months of this year. Consequently, Warren and all three partners didn’t draw a paycheck for three pay periods; hence the split. In part, the two doctors blamed the practice’s billing process and thought they could do better on their own.

Medicare problems

It shored up Warren’s already strong opinions about Medicare, TennCare, private insurance companies and his profession — and they’ve been heard often by the boards of the Memphis and county medical societies (with 1,400 physician members).

This reporter gets a sample the first morning. Warren is waiting next to his truck.

“Am I late?”

“Seven minutes,” he says.

He’s a walking utility belt. His stethoscope hangs around his neck, a pen dangles from his shirtfront, a cell phone and pager clip onto his belt, while the rest of the tools of his trade fill almost every pocket on his pants and lab coat. Then there are the cough drops and gum in his right front pocket.

“I wanted to maintain some of my Southern heritage,” says Warren, “so I kept chewing tobacco when I went to Yale.” To kick the habit he began to chew nicotine gum a few years ago, until he realized he was spending approximately $2,500 a year on the stuff. Now, other than occasional lapses, he’s replaced the nicotine gum with chewing gum and sugarless cough drops.

“It’s one of the reasons I’m so persistent with my patients to stop smoking,” he says. “But at the same time, I’m sympathetic.”

Controversial views

It’s about 6:30 a.m. He knocks on a door.

“No one’s here,” a voice says.

Warren smiles. Five years ago, he explains, she was given a few months to live. “Doctors don’t know everything.”

After rounds, Warren has a few hours off before he has to see patients at his office, so we get in his Mercedes SUV and return to his house, where he lives with his wife, K.C., a Memphis native, and their three children, and we talk about the problems facing the medical profession — and he opens the flood gates. Some of his views may be controversial, he says, but many of his colleagues share them.

Hassles, he says, don’t come from patients. They’re caused by constantly changing bureaucratic problems.

The list is long and involves the amount and kind of coverage, drugs, late payments, much more. The difficulty in getting insurance companies to pay is part of the reason he and his partners decided to expand from the 1,500 patients when he first assumed the practice in 1992 to the 10,700 they had in May.

“That helped insulate us from late payments,” he says. Warren says his practice typically has difficulty getting insurers to pay 30 to 40 percent of their monthly bills.

“I’m not sure that managed care has done anything but manage costs,” he says. “And maybe limit care.”

100 patients a day

Warren treats children and seniors, delivers babies, casts broken bones. Eighty to 100 patients are scheduled to visit his office a day but it’s staffed to see up to 140 because many must be worked in. Phone calls can number 600 to 800 on any Monday.

Back in his office, he removes a mole from a patient’s face and stitches from another patient’s finger that was almost severed by a router, gives another a shot in the heel to treat tendinitis, treats sinus problems, does routine check-ups, discusses alcoholism, sexual stamina, work-related stress and depression.

“Thirty percent of patients in primary care are clinically depressed,” says Warren. Most are on anti-depressant drugs, such as Prozac.

“With my younger patients, taking such a drug is a no-brainer. But with my older patients, a lot of them are hesitant, they think it’s a sign of weakness to get help for such a problem.

“I explain to them that it’s a physiological problem. If they had the choice between taking medication or having heart surgery, they’d take the medicine. The same can be said for anti-depressants — it’s a whole lot better than living with depression.”

11-hour days

He spends 11 hours seeing patients, spending an average of about nine minutes with each. But he slows his pace a bit when they seem to need more time.

Most wait just under an an hour, and that, Warren says, is a necessary evil because it’s caused by walk-ins who are sick.

“I’ve had patients complain about waiting,” he says. “Generally they don’t complain anymore, after they’ve been worked in.”

He sees four more this morning — a diabetic with a potentially dangerous foot injury, two others that may have suffered from strokes, and that patient with Lou Gehrig’s disease.

As soon as we enter the ventilation ward, Warren grabs his chart, takes a quick look, smiles, spins around, and heads for the room right across the hall from the unit’s front desk. His patient got his wish. He’s been moved closer to “the girls.”